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The Australian and New Zealand Journal... May 2019Hypothyroidism is a well-documented consequence of lithium treatment. Less well known is a possible association between lithium therapy and hyperthyroidism. This may...
OBJECTIVE
Hypothyroidism is a well-documented consequence of lithium treatment. Less well known is a possible association between lithium therapy and hyperthyroidism. This may have clinical implications as rapid changes in thyroid hormones may worsen a person's affective state, while symptoms of hyperthyroidism can mimic those of mania. We therefore systematically reviewed the published literature for evidence of lithium-induced hyperthyroidism.
METHODS
We searched PubMed, Embase and CINAHL for articles where individuals developed biochemically confirmed hyperthyroidism (with or without clinical symptoms), while on lithium therapy for an affective illness. We included case reports, case series, cross-sectional, case control and cohort studies.
RESULTS
We included 52 studies, 39 of which were individual case reports and 3 were case series. There were 10 cross-sectional or case control or cohort studies. All the research designs suggested an association between the prescription of lithium and hyperthyroidism. However, these findings were limited by the quality of the included studies, small number of participants and the general lack of either a clear temporal relationship or dose response.
CONCLUSION
Hyperthyroidism is an uncommon side-effect of lithium compared to hypothyroidism but may have clinical implications. However, large prospective studies are required to clarify this association and to further inform the management of patients treated with lithium where hyperthyroidism occurs.
Topics: Bipolar Disorder; Humans; Hyperthyroidism; Hypothyroidism; Lithium Compounds; Psychotic Disorders
PubMed: 30841715
DOI: 10.1177/0004867419833171 -
Journal of Critical Care Jun 2018Thyrotoxicosis-induced cardiomyopathy (TCM) is a rare, potentially life-threatening complication requiring extracorporeal membrane oxygenation (ECMO) for temporary...
PURPOSE
Thyrotoxicosis-induced cardiomyopathy (TCM) is a rare, potentially life-threatening complication requiring extracorporeal membrane oxygenation (ECMO) for temporary mechanical support while a euthyroid state is being achieved.
MATERIALS AND METHODS
The current review searched Ovid Medline and PubMed for all relevant studies reported in English from January 1, 1970 to December 31, 2017. We included studies where patients were diagnosed with thyrotoxicosis, eventually deteriorating into TCM, requiring veno-arterial ECMO. We were predominantly interested in the clinical pathway that led to the initiation and duration of ECMO, including the trend of ejection fraction (EF) pre- and post-ECMO.
RESULTS
The initial search strategy produced 71 articles of which only 5 studies were eligible for inclusion. These 5 articles included 13 case reports. The majority of the patients (77%) survived with complete recovery of their left ventricular function following initiation of VA-ECMO. Key issues in the current management of TCM are delayed recognition of the underlying thyroid hormone imbalance and when to initiate mechanical support.
CONCLUSION
The definitive therapy of TCM is returning the patient to a euthyroid state. For those patients who develop circulatory collapse, however, temporary mechanical support should be strongly considered to allow time for a euthyroid state to be achieved.
Topics: Cardiomyopathies; Extracorporeal Membrane Oxygenation; Humans; Thyrotoxicosis
PubMed: 29475150
DOI: 10.1016/j.jcrc.2018.01.026 -
Thyroid : Official Journal of the... Feb 2018In pregnant women with Graves' disease, maternal thyrotropin receptor antibodies (TRAb) can cross the placenta and induce fetal or neonatal thyrotoxicosis. Symptoms of...
BACKGROUND
In pregnant women with Graves' disease, maternal thyrotropin receptor antibodies (TRAb) can cross the placenta and induce fetal or neonatal thyrotoxicosis. Symptoms of fetal thyrotoxicosis are tachycardia, intrauterine growth restriction, and intra-uterine death. Recommendations on an upper limit of TRAb concentrations below which intensive fetal monitoring can be safely omitted vary between different guidelines. The objective of this study was to define an evidence-based cutoff level for maternal TRAb necessitating additional fetal monitoring during pregnancy.
METHODS
A literature search was performed to identify studies on pregnant women with Graves' disease and fetal and/or neonatal thyrotoxicosis. Only studies that reported TRAb were included.
RESULTS
From a total of 229 identified titles, 20 articles could be included in the analysis. A total of 53 cases of fetal and/or neonatal thyrotoxicosis were described. The lowest level of maternal TRAb leading to neonatal thyrotoxicosis was 4.4 U/L, which corresponds to 3.7 times the upper limit of normal. The level of evidence for this threshold is moderate to low.
CONCLUSION
In women with Graves' disease, intensive fetal monitoring is recommended when maternal TRAb concentrations are >3.7 times the upper limit of normal. This cutoff level should be interpreted with caution, since evidence is limited.
Topics: Autoantibodies; Female; Graves Disease; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Receptors, Thyrotropin; Thyrotoxicosis
PubMed: 29325496
DOI: 10.1089/thy.2017.0413 -
International Journal of Surgery... Feb 2017Use of intra-operative neuro-monitoring (IONM) during high-risk thyroidectomy has been suggested to decrease the rate of recurrent laryngeal nerve (RLN) palsy. However,... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Use of intra-operative neuro-monitoring (IONM) during high-risk thyroidectomy has been suggested to decrease the rate of recurrent laryngeal nerve (RLN) palsy. However, current evidences were mixed and there was no large-scale study concluding its benefit. We evaluated the role of IONM in reducing RLN palsy during high-risk thyroidectomy and identified which high-risk subgroup would be most benefited.
METHODS
A systemic review was performed to identify studies comparing the use of IONM and visual identification of RLN alone (VA) during high-risk thyroidectomy, namely re-operation, thyroidectomy for malignancy, thyrotoxicosis or retrosternal goitre. Rate of RLN palsy was presented in terms of number of nerve-at-risk (NAR). Meta-analysis on overall high-risk thyroidectomy and subgroups were performed using fixed or random-effects model.
RESULTS
Ten articles were eligible for final analysis. There were 4460 NARs in VA group and 6155 NARs in IONM group. Comparing to VA, IONM had lower rate of overall [4.5% vs. 2.5%, Odd ratio (OR): 1.40, 95% confidence interval (CI): 1.12-1.79, p = 0.003] and temporary [3.9% vs. 2.4%; OR: 1.47, 95% CI: 1.07-2.00, p = 0.016] RLN palsy in overall high-risk thyroidectomies. On subgroup analysis, although numbers of NARs were less than minimal numbers required for a statistical powered study (2.1%-72.7%), use of IONM decreased the rate of overall RLN palsy during re-operation (7.6% vs. 4.5%, OR: 1.32, p = 0.021) and temporary RLN palsy during thyroidectomy for malignancy (3.1% vs. 1.6%, OR: 1.90, p = 0.026). Use of IONM tended to have a lower rate of overall RLN palsy during thyroidectomy for malignancy than VA alone. (3.5% vs. 2.1%, p = 0.050).
CONCLUSIONS
Selective use of IONM during high-risk thyroidectomy decreased the rate of overall RLN palsy. IONM should be applied during re-operative thyroidectomy and thyroidectomy for malignancy.
Topics: Female; Humans; Intraoperative Neurophysiological Monitoring; Male; Middle Aged; Recurrent Laryngeal Nerve Injuries; Reoperation; Risk; Thyroidectomy; Vocal Cord Paralysis
PubMed: 28034775
DOI: 10.1016/j.ijsu.2016.12.039 -
Thrombosis and Haemostasis Dec 2012Several coagulation and fibrinolytic parameters appear to be affected by thyroid hormone excess; however, the net effect on the haemostatic system remains unclear. We... (Meta-Analysis)
Meta-Analysis Review
Several coagulation and fibrinolytic parameters appear to be affected by thyroid hormone excess; however, the net effect on the haemostatic system remains unclear. We aimed to update our previous review and systematically summarise and meta-analyse the data by assessing the effects of thyrotoxicosis on the coagulation and fibrinolytic system in vivo . Data sources included MEDLINE (2006-2012), EMBASE (2006-2012), and reference lists. The sources were combined with our previous search containing studies from 1980-2006. Eligible studies were all observational or experimental studies. Two investigators independently extracted data and rated study quality. Weighted mean proportion and 95% confidence intervals were calculated and pooled using a fixed and a random-effects model. A total of 29 articles consisting of 51 studies were included, as in several articles more than one study was described. We included four intervention (before and after treatment in hyperthyroid patients), five cross-sectional (hyperthyroid subjects and euthyroid controls), and four experimental (before and after use of thyroid hormone in euthyroid subjects) medium/high quality studies for meta-analysis. We found that thyrotoxicosis shifts the haemostatic balance towards a hypercoagulable and hypofibrinolytic state with a rise in factors VIII and IX, fibrinogen, von Willebrand factor, and plasminogen activator inhibitor-1. This was observed in endogenous and exogenous thyrotoxicosis, and in subclinical as well as overt hyperthyroidism. We conclude that both subclinical and overt hyperthyroidism induce a prothrombotic state, which is therefore likely to be a risk factor for venous thrombosis.
Topics: Blood Coagulation; Blood Coagulation Factors; Fibrinolysis; Humans; Hyperthyroidism; Risk Factors; Thrombosis; Thyrotoxicosis
PubMed: 23014708
DOI: 10.1160/TH12-07-0496 -
World Journal of Surgery Jul 2008Toxic multinodular goiter (Plummer's disease) has posed challenges to surgeons, endocrinologists, and radiation oncologists since its description in 1913. A literature... (Review)
Review
BACKGROUND
Toxic multinodular goiter (Plummer's disease) has posed challenges to surgeons, endocrinologists, and radiation oncologists since its description in 1913. A literature review with evidenced-based methodology has not yet been reported.
METHODS
A systematic review of the English literature from 1950 to 2007 and report of Mayo Clinic experience since 1950 was undertaken to establish evidence-based recommendations for management.
RESULTS
Surgery and radioactive iodine (RI) are both supported by level IV evidence in the treatment of solitary toxic nodules and toxic multinodular goiter, and treatment is determined by symptoms and co-morbidities. No evidence suggests a difference in treatment outcome based on pretreatment clinical or subclinical hyperthyroidism. Level IV evidence supports thyroidectomy over RI for large goiters. When compressive symptoms are present, level IV evidence supports thyroidectomy for maximal symptom relief in patients at moderate risk. Occult malignancies are found in 2-3% of thyroidectomy specimens for Plummer's disease. Despite technical reports of RI dose considerations, there are no prospective studies validating a dose formula. Ethanol ablation of toxic nodules in patients unfit for surgery is supported by level III evidence. Level V data suggest a cost benefit favoring surgery.
CONCLUSIONS
Treatment of Plummer's disease with antithyroid medications, ethanol ablation, RI ablation, or surgery must balance the goals of therapy, durability of cure, relief of symptoms, risk of malignancy, and risk of complications. Between 1950 and 2006, 948 (70%) of 1,356 patients with Plummer's disease have been treated surgically at Mayo Clinic.
Topics: Goiter, Nodular; Humans; Thyrotoxicosis
PubMed: 18357484
DOI: 10.1007/s00268-008-9566-0 -
European Journal of Endocrinology Oct 2005We assessed the effects of dose, regimen and duration of anti-thyroid drug therapy for Graves' thyrotoxicosis on recurrence of hyperthyroidism, course of ophthalmopathy,... (Review)
Review
We assessed the effects of dose, regimen and duration of anti-thyroid drug therapy for Graves' thyrotoxicosis on recurrence of hyperthyroidism, course of ophthalmopathy, adverse effects, health-related quality of life and economic outcomes. We undertook a systematic review and meta-analyses of randomised controlled trials (RCTs). We identified RCTs regardless of language or publication status by searching six databases, and trial registries. Dual, blinded data abstraction and quality assessment were undertaken. Trials included provided therapy for at least 6 months with follow-up at least 1 year after drug cessation. Fixed or random effects meta-analyses were used to combine study data. Twelve trials compared a Block-Replace regimen (requiring a higher dose of anti-thyroid drug treatment) with a Titration regimen. Overall, there was no significant difference between the regimens for relapse of hyperthyroidism (relative risk (RR) = 0.93, 95% confidence interval (CI) 0.84 to 1.03). Participants were more likely to withdraw due to adverse events with a Block-Replace regimen (RR = 1.89, 95% CI 1.25 to 2.85). Prescribing replacement thyroxine, either with the anti-thyroid drug treatment, or after this was completed, had no significant effect on relapse. Limited evidence suggested 12-18 months of anti-thyroid drug treatment should be used. The titration regimen appeared as effective as the Block-Replace regimen, and was associated with fewer adverse effects. However, relapse rates over 50% and high participant drop-out rates in trials mean that the results should be interpreted with caution, and may suggest that other strategies for the management of Graves' disease, such as radioiodine, should be considered more frequently as first-line therapy. There were no data on the course of ophthalmopathy, health-related quality of life and economic outcomes.
Topics: Antithyroid Agents; Dose-Response Relationship, Drug; Drug Therapy, Combination; Graves Disease; Humans; Randomized Controlled Trials as Topic; Thyroxine
PubMed: 16189168
DOI: 10.1530/eje.1.01993 -
Rheumatology (Oxford, England) Sep 2003After many years out of the limelight, massage therapy is now experiencing a revival. The aim of this systematic review is to evaluate its potential for harm. (Review)
Review
OBJECTIVES
After many years out of the limelight, massage therapy is now experiencing a revival. The aim of this systematic review is to evaluate its potential for harm.
METHODS
Computerized literature searches were carried out in four databases. All articles reporting adverse effects of any type of massage therapy were retrieved. Adverse effects relating to massage oil or ice were excluded. No language restrictions were applied. Data were extracted and evaluated according to predefined criteria.
RESULTS
Sixteen case reports of adverse effects and four case series were found. The majority of adverse effects were associated with exotic types of manual massage or massage delivered by laymen, while massage therapists were rarely implicated. The reported adverse events include cerebrovascular accidents, displacement of a ureteral stent, embolization of a kidney, haematoma, leg ulcers, nerve damage, posterior interosseous syndrome, pseudoaneurism, pulmonary embolism, ruptured uterus, strangulation of neck, thyrotoxicosis and various pain syndromes. In the majority of these instances, there can be little doubt about a cause-effect relationship. Serious adverse effects were associated mostly with massage techniques other than 'Swedish' massage.
CONCLUSION
Massage is not entirely risk free. However, serious adverse events are probably true rarities.
Topics: Adult; Aged; Clinical Competence; Female; Humans; Male; Massage; Middle Aged; Rheumatic Diseases
PubMed: 12777645
DOI: 10.1093/rheumatology/keg306 -
Thyroid : Official Journal of the... Oct 2002To assess the economic effects of thyroid disorder-related morbidity in Germany, a systematic review of national and international literature from 1981-2001 was... (Review)
Review
To assess the economic effects of thyroid disorder-related morbidity in Germany, a systematic review of national and international literature from 1981-2001 was performed. Data from insurance companies, the government department of public health, and the federal office of statistics helped characterize the situation in Germany. Being the most important thyroid disease, endemic iodine-deficiency goiter causes economic costs of approximately 2.1 billion DM per year or 1 billion Euros or 1 billion U.S. dollars. In recent years iodine supplementation of food became better accepted by the German population. This should significantly reduce the prevalence of goiter from 30%-40% to less than 10%. Functional thyroid disorders are observed in 5%-10% of the German population. A more differentiated view of these conditions should lead to specific guidelines for an economic screening and therapy of subpopulations. Lacking valuable data, an actual economic assessment of autoimmune or malignant thyroid diseases cannot be performed. On the other hand, with respect to the costs of specific thyroid therapy, e.g., radioiodine treatment of thyrotoxicosis (mainly toxic nodular goiter), the economic consequences of a new regulation for radiation protection in Germany have been demonstrated recently. Using the actual maximum permissible level of residual activity on discharge from the hospital after radioiodine therapy, length of hospitalization was shortened to 5.1 days in university hospitals and to 5.8 days in nonuniversity institutions. Payment per patient for radioiodine therapy was 1,856 and 1,530 Euros (median value) in university and nonuniversity hospitals, respectively. In conclusion, better prevention of iodine deficiency and its long-term consequences should effectively reduce direct as well as indirect costs and overall economic impact of endemic goiter as the most important thyroid disease in Germany. Sustainable elimination of iodine deficiency is technically possible, but it needs further commitment and support at all levels.
Topics: Costs and Cost Analysis; Germany; Humans; Thyroid Diseases
PubMed: 12487774
DOI: 10.1089/105072502761016548